Editor’s Pick, March 2016: Marco Annoni and Franklin G. Miller

The Editor’s Pick for March 2016 is Franklin Miller and Marco Annoni’s paper, “Placebo Effects and the Ethics of Therapeutic Communication: A Pragmatic Approach.” This paper challenges one of the most fundamental metaethical pillars of traditional bioethics: the distinction between therapy and communication about therapy. Traditionally, we think that protecting autonomy requires communication about therapeutic possibilities before any therapy can begin; imposing therapy before obtaining informed consent may be beneficent, but it constitutes a paternalistic violation of autonomy. Miller and Annoni examine “therapeutic communication”: communication that enhances placebo effects in virtue of its manipulation of patient expectations. Placebo studies “demonstrate that the way in which health professionals communicate, disclose, frame, and contextualize information to patientsmay modulate symptoms across an array of highly prevalent conditions.” Thus “communication by clinicians has the power to turn diagnoses and prognoses into parts of the treatment.” Hence there is not always a neat distinction between communication and therapy, or between beneficence and autonomy considerations. This is a crucial challenge to the nearly universally presupposed division of ethical labor in medical care.